摘要: 目的：选取枣庄市精神卫生中心120例精神分裂症患者，随机数字表法分两组，各60例。对照组口服盐酸齐拉西酮胶囊，研究组在此基础上联合重复经颅磁刺激，对比精神症状[简明精神病量表(BPRS)]、心率变异性[24 h内全部相邻正常心动周期差值均方根(RMSSD)、24 h内每5 min节段平均窦性R-R间期标准差(SDANN)、24 h内全部窦性心搏R-R间期的标准差(SDNN)、24 h内相邻R-R间期差值大于50 ms心搏占正常心搏总数百分比(PNN50)]、攻击行为[外显攻击行为量表(MOAS)]、睡眠质量[匹兹堡睡眠质量指数(PSQI)]。结果：干预前，两组各项评分与指标对比(
P > 0.05)；干预后，研究组BPRS评分中，焦虑抑郁为16.98 ± 3.75分，缺乏活力为12.47 ± 2.34分，思维障碍为14.38 ± 2.52分，激活性为8.29 ± 2.78分，敌对猜疑为7.96 ± 1.63分，对照组BPRS评分中，焦虑抑郁为19.82 ± 3.32分，缺乏活力为18.83 ± 2.67分，思维障碍为18.62 ± 2.29分，激活性为11.37 ± 2.35分，敌对猜疑为11.25 ± 1.92分，研究组症状严重程度低于对照组(
t: 4.392, 13.876, 9.645, 6.554, 10.118,
P < 0.05)，干预后，研究组心率变异性中，RMSSD为45.28 ± 3.76 ms，SDANN为112.38 ± 6.23 ms，SDNN为105.25 ± 2.52 ms，PNN50为15.49% ± 3.84%，对照组心率变异性中，RMSSD为35.62 ± 3.63 ms，SDANN为92.76 ± 5.68 ms，SDNN为98.37 ± 3.72 ms，PNN50为11.83% ± 4.85%，干预后，对照组心率变异性各项指标显著降低，研究组未见明显变化，且研究组心率变异性优于对照组(
P < 0.05)，研究组攻击行为低于对照组(
P < 0.05)，研究组PSQI评分中，睡眠效率为1.46 ± 0.34分，睡眠质量为1.37 ± 0.26分，入睡时间为1.52 ± 0.25分，催眠药物为1.12 ± 0.31分，睡眠时间为1.31 ± 0.27分，睡眠障碍为1.19 ± 0.43分，日间功能障碍为1.46 ± 0.63分，对照组PSQI评分中，睡眠效率为1.83 ± 0.27分，睡眠质量为1.79 ± 0.18分，入睡时间为1.96 ± 0.37分，催眠药物为1.75 ± 0.42分，睡眠时间为1.86 ± 0.34分，睡眠障碍为1.82 ± 0.16分，日间功能障碍为1.93 ± 0.37分，研究组PSQI评分较低(
P < 0.05)。结论：重复经颅磁刺激联合齐拉西酮对精神分裂症患者能够改善精神症状，对患者心率影响较小，降低患者攻击行为，提高睡眠质量。
Abstract: Objective: To select 120 patients with schizophrenia from Zaozhuang Mental Health Center and divide them into two groups with 60 cases each by random number table method. The control group took ziprasidone hydrochloride capsule orally, and the study group combined repeated transcranial magnetic stimulation on this basis. Psychiatric symptoms [Brief Psychiatric Scale (BPRS)], heart rate variability [root mean square difference of all adjacent normal cardiac cycles within 24 hours (RMSSD), mean sinus R-R interval standard deviation per 5 min segment within 24 hours (SDANN), standard deviation of all sinus beats R-R interval within 24 hours (SDNN), and adjacent R- within 24 hours R-interval difference greater than 50 ms percentage of total normal heart beats (PNN50), aggressive behavior [Explicit Aggressive Behavior Scale (MOAS)], and sleep quality [Pittsburgh Sleep Quality Index (PSQI)]. Results: Before intervention, the scores and indexes of the two groups were compared (P > 0.05). After the intervention, the BPRS score of the study group was 16.98 ± 3.75 points for anxiety and depression, 12.47 ± 2.34 points for lack of vitality, 14.38 ± 2.52 points for thinking disorder, 8.29 ± 2.78 points for activation, 7.96 ± 1.63 points for hostile suspicion. Anxiety and depression were 19.82 ± 3.32 scores, inactivity 18.83 ± 2.67 scores, thinking disorder 18.62 ± 2.29 scores, activation 11.37 ± 2.35 scores, hostile suspicion 11.25 ± 1.92 scores, the severity of symptoms in the study group was lower than that in the control group (t: 4.392, 13.876, 9.645, 6.554, 10.118, P < 0.05). After intervention, the RMSSD, SDANN and SDNN were 45.28 ± 3.76 ms, 112.38 ± 6.23 ms and 105.25 ± 2.52 ms respectively. PNN50 was 15.49% ± 3.84%, RMSSD was 35.62 ± 3.63 ms, SDANN was 92.76 ± 5.68 ms, SDNN was 98.37 ± 3.72 ms, and PNN50 was 11.83% ± 4.85% in the control group. All indexes of heart rate variability in the control group were significantly decreased, while no significant changes were observed in the study group. The heart rate variability in the study group was better than that in the control group (P < 0.05), and the aggressive behavior in the study group was lower than that in the control group (P < 0.05). The PSQI score of the study group was 1.46 ± 0.34 points, and the sleep quality was 1.37 ± 0.26 points. Sleep time was 1.52 ± 0.25 points, hypnotic drugs 1.12 ± 0.31 points, sleep time 1.31 ± 0.27 points, sleep disorders 1.19 ± 0.43 points, daytime dysfunction 1.46 ± 0.63 points. In the PSQI score of the control group, sleep efficiency was 1.83 ± 0.27 points. Sleep quality was 1.79 ± 0.18 points, sleep time was 1.96 ± 0.37 points, hypnotic drugs were 1.75 ± 0.42 points, sleep time was 1.86 ± 0.34 points, sleep disorders were 1.82 ± 0.16 points, daytime dysfunction was 1.93 ± 0.37 points, PSQI score was lower in the study group (P < 0.05). Conclusion: Repetitive transcranial magnetic stimulation combined with ziprasidone can improve mental symptoms, have little effect on heart rate, reduce aggressive behavior and improve sleep quality in patients with schizophrenia.